Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis Clinical Pharmacy and Pharmacology

However, for some patients they may provide an adjunctive benefit in maintaining changes brought about by other drug and alcohol treatments, a finding that needs more replication. Currently, there is not enough evidence base to support the effectiveness of 12-step programs as stand-alone interventions. A number of substance abuse treatment strategies have derived from operant
learning principles. While they are often incorporated into broad-spectrum
cognitive-behavioral approaches, they have also been used as independent forms
of treatment.

Finally, we speculate how CBT may evolve during the next 30 years, if informed by developments in technology, cognitive science and neuroscience. It should be noted that this review will for the most part concentrate on “classical CBT” rather than its many variants, including behavioral couples training, adaptations for specific comorbid conditions (such as mood management interventions), or combined approaches (such as the Community Reinforcement Approach). CBT for substance use disorders captures a broad range of behavioral treatments including those targeting operant learning processes, motivational barriers to improvement, cognitive behavioral interventions for substance abuse and traditional variety of other cognitive-behavioral interventions. Overall, these interventions have demonstrated efficacy in controlled trials and may be combined with each other or with pharmacotherapy to provide more robust outcomes. Despite this heterogeneity, core elements emerge based in a conceptual model of SUDs as disorders characterized by learning processes and driven by the strongly reinforcing effects of substances of abuse. Particular challenges to the field include the determination of the most effective combination treatment strategies and improving the dissemination of CBT to service provision settings.

Cognitive-Behavioral Therapy (CBT) for Addiction and Substance Abuse

In early review, a robust benefit of combined CBT with other psychosocial therapies such as MI and CM was observed. These effects have been observed in trials targeting alcohol use with co-occurring depression, cannabis use, and cocaine use. However, the additive effect of these combined interventions, despite clinically intuitive expectations of their compatibility, and even synergy, has not received conclusive support. Robust evidence suggests the efficacy of classical/traditional CBT compared to minimal and usual care control conditions. CBT combined with another evidence-based treatment such as Motivational Interviewing, Contingency Management, or pharmacotherapy is also efficacious compared to minimal and usual care control conditions, but no form of CBT consistently demonstrates efficacy compared to other empirically-supported modalities.

This is a significant gap, given the role meta-analysis plays in guiding clinical practice decisions at both micro (e.g., individual providers) and macro (e.g., community agency administrators, public service funders) levels. However, several studies assessing the effect of cognitive behavioral approach on anger management came to contradictory results. For instance, Ozabaci conducted a meta-analysis in 2011 and found that this approach was not as effective as expected in aggression among children and adolescents [22].

Anger management in substance abuse based on cognitive behavioral therapy: an interventional study

However, it can be conducted
in less time–for instance, once per week for six to eight sessions. Main Outcomes and Measures 
Substance use frequency and quantity outcomes after treatment and during follow-up were examined. AIncludes studies diverted to other meta-analytic reports on CBT without pharmacotherapy, technology-delivered CBT, and CBT with dual-disorder populations. When you can identify these patterns, you start to work with your therapist on changing your negative thoughts into positive, healthier ones. Severe substance use disorder, or addiction, is repeated drug use despite harmful effects, and not being able to stop using the substance. A more recent development in the area of managing addictive behaviours is the application of the construct of mindfulness to managing experiences related to craving, negative affect and other emotional states that are believed to impact the process of relapse34.

• Self-efficacy has been thought of as both the degree of a client’s temptation
  to use in substance-related settings and his degree of confidence in his
  ability to refrain from using in those settings (Annis and Davis, 1988b; DiClemente et al., 1994; Sklar et al., 1997).
• Early learning theories and later social cognitive and cognitive theories have had a significant influence on the formulation CBT for addictive behaviours.
• Despite the richness of its theoretical foundations, the literature thus far has not provided a clear picture of how CBT exerts its effects on AOD outcomes.
• If someone is at the point where they need professional treatment for their addiction, chances are they are using alcohol or drugs as their main means of coping with problems.
• When the minimal effective response (such as informing friends that “I do not drink”) is not sufficient to bring about change, the individual is instructed to escalate to a stronger response, such as warning, threat, involving others’ support.

Focusing on individuals with cannabis use disorders, Budney and colleagues developed a computerized approach encompassing MI, CBT and contingency management (Budney et al., 2015). In a randomized controlled trial, 75 adults with marijuana use disorder were randomized to 2 sessions of brief treatment versus a 9-session clinician-delivered MET-CBT approach, or a 9-session version of TES emphasizing MET and CBT. Both MET/CBT conditions included a CM component in which participants could earn up to $435 in gift cards if all urines were negative for cannabis. Significantly more participants in clinician-delivered treatment (44.8%) and TES (46.7%) were abstinent at the end of treatment compared with the 2-session brief treatment (12.5%). Similarly, both the therapist- and computer delivered approaches were significantly more effective in reducing cannabis use compared with brief intervention alone during treatment, but effects weakened during follow-up and were no longer significant at the 6-month follow-up point.

Functional Analysis

Patterns of movement through the various stages are categorized as stable, progressive or unstable11. Rajiv’s unsuccessful attempts at abstinence lead https://ecosoberhouse.com/ to a low sense of self-confidence and a belief that he would not be able help himself (low perceived self- efficacy) setting up a vicious cycle.